100+ Free NZREX Clinical Practice Questions

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A 68-year-old man collapses with crushing central chest pain and the ECG confirms an acute STEMI. While awaiting reperfusion, which initial medication combination is appropriate?

A laxative and antiemetic only

Aspirin (loading dose), with consideration of a second antiplatelet, plus analgesia and oxygen if hypoxic

A loop diuretic alone

Oral antibiotics and discharge

to track

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2026 Statistics

Key Facts: NZREX Clinical Exam

NZREX Clinical is a 12-station OSCE from the Medical Council of New Zealand for overseas-trained doctors, run over about three hours with all stations equally weighted. The five-year average pass rate is about 66 percent, and the 2026 fee is approximately NZD 5,531.

Sample NZREX Clinical Practice Questions

Try these sample questions to test your NZREX Clinical exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents with central chest pain. To distinguish stable angina from an acute coronary syndrome during history taking, which feature most strongly suggests an unstable presentation requiring urgent assessment?

A.Chest pain that now occurs at rest or with minimal exertion and is increasing in frequency

B.Pain that is reliably relieved within 2-3 minutes of rest

C.Pain reproduced by palpation of the chest wall

D.Pain present unchanged for the past 3 years on exertion

Explanation: Crescendo angina, new rest pain, or pain on minimal exertion indicates unstable angina/ACS and warrants urgent ECG, troponin and acute management. Identifying this through targeted history is a core NZREX clinical-reasoning skill.

2In an NZREX history-taking station, a patient reports new-onset headache. Which single feature is the strongest red flag prompting consideration of subarachnoid haemorrhage?

A.Gradual onset over several days with photophobia

B.Bilateral tightness relieved by paracetamol

C.Thunderclap onset reaching maximum intensity within seconds to a minute

D.Headache worse in the afternoon after screen work

Explanation: A thunderclap headache reaching peak severity within seconds is the classic red flag for subarachnoid haemorrhage and mandates urgent imaging. Eliciting onset and time-to-peak is the key discriminating history question.

3A 24-year-old woman of childbearing age presents with lower abdominal pain. Which question is the single most important to ask early in the history?

A.Her dietary fibre intake

B.Date of her last menstrual period and possibility of pregnancy

C.Whether she exercises regularly

D.Her childhood immunisation history

Explanation: In any woman of reproductive age with abdominal pain, ectopic pregnancy must be excluded; establishing LMP and pregnancy possibility (and ordering a beta-hCG) is the priority. This is a recurring NZREX safety point.

4When taking a history from a patient with possible depression in an NZREX station, which screening approach best assesses immediate safety?

A.Ask only about sleep and appetite changes

B.Ask the family instead of the patient

C.Avoid mentioning suicide to prevent distress

D.Directly and sensitively ask about thoughts of self-harm or suicide, including any plan

Explanation: Directly but sensitively asking about suicidal ideation, intent and plan is essential and does not increase risk. Risk assessment is a mandatory communication and safety competency in NZREX psychiatry stations.

5A patient presents with breathlessness. Which combination of history features best supports a diagnosis of congestive heart failure rather than COPD?

A.Orthopnoea, paroxysmal nocturnal dyspnoea and bilateral ankle swelling

B.Long smoking history with chronic productive cough and wheeze

C.Sudden pleuritic chest pain after a long flight

D.Seasonal wheeze relieved by a salbutamol inhaler

Explanation: Orthopnoea, paroxysmal nocturnal dyspnoea and peripheral oedema are hallmark symptoms of left and right heart failure. Eliciting this triad in the history strongly points to CHF over obstructive lung disease.

6Taking a history from a Maori patient with diabetes, which approach best reflects culturally safe practice expected in NZREX?

A.Assume cultural beliefs based on ethnicity and proceed accordingly

B.Avoid discussing culture to remain neutral

C.Ask the patient about their own values, who they want involved (whanau), and their health goals

D.Refer the patient to a different doctor

Explanation: Cultural safety, an explicit NZREX domain, means recognising the patient as the expert on their own culture and asking about their values, whanau involvement and goals rather than making assumptions. This supports the Treaty of Waitangi principle of equity.

7A 3-year-old is brought in with fever and irritability. Which history feature most raises concern for serious bacterial infection or meningitis?

A.Mild runny nose for one day and good oral intake

B.Reduced responsiveness, refusing fluids, and a non-blanching rash reported by the parent

C.Single temperature of 38.0 C that settled with paracetamol

D.A sibling with a recent cold

Explanation: Lethargy/reduced responsiveness, poor fluid intake and a non-blanching rash are high-risk red flags for serious bacterial infection or meningococcal disease in a febrile child. These must be actively elicited and acted on urgently.

8During a medication history, a patient on warfarin reports starting a new course of an antibiotic and now has gum bleeding. Which is the most relevant immediate concern to clarify?

A.Whether the patient took the antibiotic with food

B.Whether the patient prefers tablets or capsules

C.The colour of the antibiotic packaging

D.Whether the antibiotic has potentiated the anticoagulant effect, raising the INR

Explanation: Many antibiotics (e.g. metronidazole, trimethoprim, macrolides) potentiate warfarin and raise the INR, increasing bleeding risk. Recognising this interaction and arranging an urgent INR check is the key clinical-reasoning step.

9A patient describes intermittent claudication. Which history feature best characterises this symptom of peripheral arterial disease?

A.Calf pain that comes on with walking a predictable distance and is relieved by rest

B.Burning foot pain worse at night relieved by walking

C.Sharp shooting pain down the back of the leg from the spine

D.Diffuse leg ache present constantly regardless of activity

Explanation: Intermittent claudication is reproducible calf (or buttock/thigh) pain brought on by a predictable walking distance and relieved within minutes by rest, reflecting demand-ischaemia of the muscle. This pattern distinguishes PAD from neuropathic or radicular pain.

10A young adult presents with a 6-week history of fatigue, weight loss and night sweats. Which additional history question best targets a possible serious underlying cause?

A.Preferred type of exercise

B.Favourite foods

C.Presence of lymph node swelling, fevers, and any foreign travel or TB contact

D.Screen time per day

Explanation: Weight loss, night sweats and fatigue are constitutional 'B symptoms' that warrant asking about lymphadenopathy, fevers, TB exposure and travel to investigate lymphoma, TB or other serious disease. Targeted systemic questioning drives the differential.

About the NZREX Clinical Exam

The New Zealand Registration Examination (NZREX Clinical) is an Objective Structured Clinical Examination run by the Medical Council of New Zealand to assess whether overseas-trained doctors can practise medicine safely in New Zealand. Candidates rotate through 12 equally weighted stations over about three hours, demonstrating history taking, physical examination, diagnosis, investigation, management, communication and cultural safety across common presentations. Eligibility requires a prior recognised MCQ examination (the AMC MCQ, USMLE Steps 1 and 2, PLAB Part 1, or MCCQE Part I) passed within five years.

Assessment

An OSCE of 12 equally weighted stations (including linked pre-reading stations) plus 2 to 4 rest stations, run over about 3 hours.

Time Limit

Approximately 3 hours; each station is about 12 minutes (around 2 minutes reading then 10 minutes with a simulated patient and examiner).

Passing Score

No fixed percentage is published. The cut score is set per sitting using internationally recognised OSCE standard-setting (borderline regression); all stations are weighted equally and the five-year average pass rate is about 66 percent. A pass is valid for five years.

Exam Fee

Approximately NZD 5,531 in 2026 (about NZD 817 application fee plus about NZD 4,714 examination fee), paid to the Medical Council of New Zealand. (Medical Council of New Zealand (Te Kaunihera Rata o Aotearoa))

NZREX Clinical Exam Content Outline

20%

History Taking

Focused, relevant histories across common presentations, with red-flag identification and exploration of patient concerns.

15%

Physical Examination

Safe, systematic, targeted examination of major systems with correct technique and interpretation of signs.

20%

Diagnosis and Clinical Reasoning

Generating prioritised differentials and recognising not-to-miss conditions across major disciplines.

12%

Investigations and Interpretation

Selecting and interpreting common tests such as ECG, blood gases, bloods, imaging and validated scores.

20%

Management and Treatment

Safe initial and ongoing management aligned with New Zealand formulary and resuscitation standards.

Communication and Cultural Safety

Patient-centred communication, breaking bad news, interpreters, and culturally safe care for Maori and all patients.

Professionalism and Ethics

Consent, confidentiality, capacity, safeguarding, open disclosure and patient-safety responsibilities.

How to Pass the NZREX Clinical Exam

What You Need to Know

Passing score: No fixed percentage is published. The cut score is set per sitting using internationally recognised OSCE standard-setting (borderline regression); all stations are weighted equally and the five-year average pass rate is about 66 percent. A pass is valid for five years.
Assessment: An OSCE of 12 equally weighted stations (including linked pre-reading stations) plus 2 to 4 rest stations, run over about 3 hours.
Time limit: Approximately 3 hours; each station is about 12 minutes (around 2 minutes reading then 10 minutes with a simulated patient and examiner).
Exam fee: Approximately NZD 5,531 in 2026 (about NZD 817 application fee plus about NZD 4,714 examination fee), paid to the Medical Council of New Zealand.

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NZREX Clinical Study Tips from Top Performers

1Practise structured OSCE stations under timed conditions, since each station gives about two minutes of reading then ten minutes with a simulated patient and examiner.

2Master safe, systematic examination routines and red-flag recognition across medicine, surgery, paediatrics, obstetrics, psychiatry and general practice.

3Prepare explicitly for communication and cultural safety, including working with interpreters and providing equitable, culturally safe care for Maori under Te Tiriti o Waitangi.

4Align management answers with New Zealand standards (NZ Formulary medicines, NZ Resuscitation Council algorithms) rather than your country of training.

Frequently Asked Questions

What is the NZREX Clinical exam?

NZREX Clinical is an Objective Structured Clinical Examination (OSCE) run by the Medical Council of New Zealand to assess whether overseas-trained doctors can practise medicine safely in New Zealand. It tests history taking, examination, diagnosis, management, communication and cultural safety.

How many stations are in the NZREX Clinical and how long is it?

The exam has 12 equally weighted clinical stations (including linked pre-reading stations) plus two to four rest stations, run over about three hours, with each station lasting roughly 12 minutes.

What is the pass mark for NZREX Clinical?

There is no published fixed percentage. The cut score is set for each sitting using internationally recognised OSCE standard-setting methods, and the average pass rate over the last five years is about 66 percent. A pass is valid for five years.

What are the eligibility requirements for NZREX Clinical?

Candidates must hold a recognised primary medical qualification and have passed an approved MCQ examination within five years: the Australian Medical Council MCQ, USMLE Steps 1 and 2, PLAB Part 1, or MCCQE Part I, alongside meeting English language requirements.

How much does the NZREX Clinical cost in 2026?

The total fee is approximately NZD 5,531 in 2026, made up of an application fee of about NZD 817 and an examination fee of about NZD 4,714, paid to the Medical Council of New Zealand. The exam is held in Auckland.